1. What are the side effects of PERT?
3. Are they safe to take long term?
4. Will this medication eventually stop working?
5. Do I really need to take all these pills?
6. Why can’t I take over-the-counter digestive enzymes?
2. Will I need to take this medication forever?
9. Will I have to take these medications forever?
8. Will I be able to afford this medication?
7. JAK inhibitors are still pretty new – are you sure they’re safe?
6. I read that JAK inhibitors increase the risk of blood clots. Should I be worried?
5. Can taking a JAK inhibitor cause cancer?
4. Why do I need to get certain vaccinations first?
3. Will taking a JAK inhibitor shut down my immune system?
2. If one JAK inhibitor doesn’t help me, does that mean none of them will?
1. Which JAK inhibitor is most likely to help me?
FAQs About PERT
for EPI, Answered
Fortunately, PERT usually doesn’t cause serious side effects; the most common ones are gas, abdominal pain, headache, or dizziness. PERT may also increase your risk of fibrosing colonopathy, a rare bowel disorder. Some people feel constipated when they start taking PERT, says Freedman. (That’s usually because the PERT is restoring their bowel movements back to what they were before they started having EPI, a condition that tends to cause loose stools.) Talk to your doctor about whether it makes sense to add more fiber or even a laxative to your diet.
Make sure you tell your doctor if you have a pork allergy, too. Because the FDA-approved pancreatic enzymes are derived from pigs, people with pork allergies could have an allergic reaction to the drugs, although this is incredibly rare, says Freedman. Tell your doctor, too, if you have a history of gout, because PERT can contribute to flares. PERT helps you break down proteins, and one of the byproducts of this metabolism is uric acid, the culprit behind gout, he says.
1. What are the side effects of PERT?
In most cases, yes. “If you have EPI, generally this is a long-term issue that requires lifelong therapy,” says Freedman. One exception is people with celiac disease, who sometimes develop EPI because their disease inflames their intestines. Once the celiac disease is treated, the patient’s pancreatic function can resume, and their EPI can resolve, he says.
Generally, yes. These enzymes have been on the market for decades, says Freedman. There is a theoretical risk that the pig-derived enzymes could contain a virus that transmits to humans, but that has never been seen. It’s also possible that a disease outbreak in pigs could affect the supply of pancreatic enzymes, and “that’s actually more of a concern than the theoretical risk of some virus transmission,” says Freedman.
It’s unlikely that the enzymes will stop working, says Freedman. Rarely, a person may switch brands if they are not satisfied with their regimen, but if it seems like the PERT is not working, the cause is usually some other gastrointestinal issue that a doctor can help you address, says Freedman.
People often wonder if it’s truly necessary to take several capsules with meals and snacks, especially if their EPI doesn’t cause many noticeable symptoms, like diarrhea, weight loss, or steatorrhea. “Sometimes they don’t have a lot of those symptoms, and still, their body is still having some issues with reduced digestion and absorption,” says Forsmark.
For example, people with EPI might have low levels of fat-soluble vitamins like vitamins D and E or osteoporosis because of poor nutrient absorption. That’s why it’s important to take your medication as prescribed, even if it seems like a lot. The enzymes you’re taking in pill form are still only about 5 percent to 10 percent of what a healthy pancreas would produce, says Forsmark.
The digestive enzyme supplements on store shelves don’t contain enough of the enzymes you need to allow normal digestion, says Forsmark.